Organization
PAIN SPECIALISTS OF IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORI D ANDERSON (BILLING MANAGER)
(208) 522-7246
Entity
Organization
Contact information
Practice address
2375 E SUNNYSIDE RD STE J, IDAHO FALLS, ID 83404-8281
(208) 522-7246
(208) 529-2620
Mailing address
2375 E SUNNYSIDE RD STE J, IDAHO FALLS, ID 83404-8281
(208) 522-7246
(208) 529-2620
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
SPHY11061
ID
Other
Enumeration date
03/12/2012
Last updated
03/12/2012
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